Dear all:

Laurie Nommson-Rivers did an excellent presentation using ROC curves concerning the sensitivity and specificity of diaper counts.  My conclusion is the same as hers -- you cannot rely on diaper counts alone.  

Personally, I believe swallowing (which is the first visible indicator of intake) and behavior (which is the second visible indicator of intake) are much more indicative of how an INDIVIDUAL baby is doing. This is because individual babies have individual needs.  Averages do not always capture these individual needs.  Both of these indicators happen BEFORE output slows and this happens BEFORE there is an impact on WEIGHT.  So if you want to prevent WEIGHT LOSS and inadequate WEIGHT GAIN for a particular baby, it makes more sense to watch, listen and feel what a baby is doing before, during and after feedings.

If a baby is in homeostatic regulation, they can compensate for variations in intake over time with behavior -- asking more assertively to be fed or conserving energy or conserving energy.  By the time weight loss or poor gain has occurred, they are out of balance.  

I still think of a scale as the type of tool you use in cooking.  Good cooks don't always need the measurement utensils, relying on scent and taste and appearance while cooking.  They may use measurement tools for special circumstances that require very precise amounts of ingredients such as in baking French pastries.  For those who are beginners at cooking (or like my husband who can't cook without a recipe) you may appreciate that measuring cup or teaspoon until you gain confidence.

Both TOO MUCH and TOO LITTLE emphasis have been placed on the scale.  The scale is blamed for making mothers more anxious, when in reality it is the PERSON who is using the scale who may not have sufficient counseling skills who may end up stressing a mother out when she/he intended quite the opposite.  I use the scale as a training tool in a society that is fixated on measurement -- to wean mothers away from numbers and towards observing, responding and interacting with their BABY, not the numbers in a book. 

As I have repeated MANY times before -- ANY OBSERVATiON that you make on a one time basis, whether it is suck/swallow rhythm, behavior, diapers or weight is subject to undependability.   Undependability is how a particular indicator changes over time.  For instance, if you measure someone's height in the morning it will be taller than in the evening.  People shrink in height during the day because they sit or stand.  

Best, Susan Burger, MHS, PhD, IBCLC

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